A Randomized Study of Family-Focused Psychoeducation and Pharmacotherapy in the Outpatient Management of Bipolar Disorder
Archives of General PsychiatryPublished 1 September 2003
David J. Miklowitz, Elizabeth George, Jeffrey A. Richards, Teresa L. Simoneau, Richard L. Suddath
Citations639
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
Abstract
Combining family psychoeducation with pharmacotherapy enhances the postepisode symptomatic adjustment and drug adherence of bipolar patients.
Keywords
PsychologyMedicine
Springer series in statisticsNonparametric Estimation from Incomplete Observations
45,533 Citations1992Edward L. Kaplan, Paul Meier
BiometricsRandom-Effects Models for Longitudinal Data
8,915 Citations1982Nan M. Laird, James H. Ware
A unified approach to fitting these models, based on a combination of empirical Bayes and maximum likelihood estimation of model parameters and using the EM algorithm, is discussed.
Archives of General PsychiatryThe Structured Clinical Interview for DSM-III-R (SCID)
4,364 Citations1992Robert L. Spitzer
The history, rationale, and development of the Structured Clinical Interview for DSM-III-R (SCID) is described, which is a semistructured interview for making the major Axis I DSM- III-R diagnoses.
Journal of Abnormal PsychologyVulnerability: A new view of schizophrenia.
1,951 Citations1977Joseph Zubin, Bonnie Spring
American Journal of PsychiatryRelapse and impairment in bipolar disorder
764 Citations1995Michael Gitlin, Joël Swendsen +2 more
Even aggressive pharmacological maintenance treatment does not prevent relatively poor outcome in a significant number of bipolar patients, and poor psychosocial outcome paralleled poor syndromal course.
American Journal of PsychiatryThe enduring psychosocial consequences of mania and depression
660 Citations1993William Coryell, William A. Scheftner +4 more
The psychosocial impairment associated with mania and major depression extends to essentially all areas of functioning and persists for years, even among individuals who experience sustained resolution of clinical symptoms.
Schizophrenia BulletinThe Effect of Family Interventions on Relapse and Rehospitalization in Schizophrenia--A Meta-analysis
646 Citations2001G. Pitschel-Walz, S. Leucht +3 more
It is indicated that psychoeducational interventions are essential to schizophrenia treatment and the bifocal approach, which offers psychosocial support to relatives and schizophrenia patients in addition to medical treatment, was clearly superior to the medication-only standard treatment.
Archives of General PsychiatryFamily Factors and the Course of Bipolar Affective Disorder
613 Citations1988David J. Miklowitz
Levels of intrafamilial EE and AS were found to predict likelihood of patient relapse at follow-up, especially when used as conjoint predictors of patient outcome status.
BMJRandomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment
589 Citations1999Amy Perry, Nicholas Tarrier +3 more
Teaching patients with bipolar disorder to recognise early symptoms of manic relapse and seek early treatment is associated with important clinical improvements in time to first manic relapse, social functioning, and employment.
Archives of General PsychiatryFamily Management in the Prevention of Morbidity of Schizophrenia
586 Citations1985Ian R. H. Falloon
The relative efficacy of the family approach did not appear to be due to prognostic factors, rater bias, stressful life events, or the effectiveness of pharmacotherapy, and Definitive tests of these findings with respect to efficacy require further well-designed studies.
PubMedA randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year.
585 Citations2003Dominic Lam, Edward Watkins +6 more
The findings support the conclusion that CT specifically designed for relapse prevention in bipolar affective disorder is a useful tool in conjunction with mood stabilizers.
Archives of General PsychiatryMultiple-Family Groups and Psychoeducation in the Treatment of Schizophrenia
559 Citations1995William R. McFarlane
It is suggested that the multiple-family group is a preferable vehicle for assisting families and treating and rehabilitating persons with schizophrenia within a psychoeducational clinical framework.
Biological PsychiatryRationale, design, and methods of the systematic treatment enhancement program for bipolar disorder (STEP-BD)
542 Citations2003Gary S Sachs, Michael E. Thase +16 more
The methodology used for the selection and certification of the clinical treatment centers, training study personnel, the general approach to clinical management, and the sequential treatment strategies offered in the STEP-BD standard and randomized care pathways for bipolar depression and relapse prevention are reviewed.
Archives of General PsychiatryOutcome in Mania
536 Citations1990Mauricio Tohen
A 4-year follow-up of 75 patients was conducted to investigate outcome after recovery from an episode of mania, and predictors of an unfavorable outcome included poor occupational status prior to index episode, history of previous episodes, and history of alcoholism, psychotic features and symptoms during the index manic episode.
Archives of General PsychiatryDrug and Family Therapy in the Aftercare of Acute Schizophrenics
522 Citations1978Michael J. Goldstein
Relapses during the six-week period and at six-month follow-up were least in patients who received both high-dose and family therapy (0%) and greatest at six months only for therapy patients originally receiving the high drug dose.
Archives of General PsychiatryFamily Psychoeducation, Social Skills Training, and Maintenance Chemotherapy in the Aftercare Treatment of Schizophrenia
506 Citations1991Gerard E. Hogarty
Results have now been obtained after 2 years of continuous treatment, and a persistent and significant effect of family intervention on forestalling relapse was observed, but the effect of social skills training was lost late in the 2nd year.
Journal of Consulting and Clinical PsychologyEmpirically supported couple and family interventions for marital distress and adult mental health problems.
495 Citations1998Donald H. Baucom, Varda Shoham +3 more
The British Journal of PsychiatryThe Community Management of Schizophrenia
470 Citations1988Nicholas Tarrier, Christine Barrowclough +5 more
Relapse rates over nine months after discharge were significantly lower for patients in the two Behavioural Intervention, compared with Education Only and Routine Treatment groups, which give partial support for the causal role of EE in relapse.
Schizophrenia BulletinDevelopmental Processes in Schizophrenic Disorders: Longitudinal Studies of Vulnerability and Stress
466 Citations1992Keith H. Nuechterlein, Michael E. Dawson +6 more
The Developmental Processes in Schizophrenic Disorders project is a longitudinal study of schizophrenic patients who have recently had a first episode of psychosis and prospective data suggest that signs and symptoms prodromal to psychotic relapse may be present in about 60 percent of patients.
American Journal of Psychiatry12-Month Outcome of Patients With Bipolar Disorder Following Hospitalization for a Manic or Mixed Episode
458 Citations1998PE Keck, Susan L. McElroy +6 more
New England Journal of MedicineComparison of Standard and Low Serum Levels of Lithium for Maintenance Treatment of Bipolar Disorder
449 Citations1989Alan J. Gelenberg, John M. Kane +5 more
D doses resulting in serum lithium levels from 0.8 to 1.0 mmol per liter are more effective in treating bipolar disorder than those that result in lower serum lithium concentrations, although the higher doses are associated with a higher incidence of side effects.
New England Journal of MedicineControversy in Counting and Attributing Events in Clinical Trials
411 Citations1979David L. Sackett, Michael Gent
An attempt is made to establish a procedure to estimate the number of events in a randomized clinical trial and to determine which treatment should be blamed for these events.
American Journal of PsychiatryResearch update on the psychosocial treatment of schizophrenia
407 Citations1996David L. Penn, Kim T. Mueser
The efficacy of a variety of different family intervention models, as well as social skills training, is supported by a large body of research.
The British Journal of PsychiatryA Controlled Trial of Social Intervention in the Families of Schizophrenic Patients: Two Year Follow-up
404 Citations1985Julian Leff, Liz Kuipers +2 more
A trial of social intervention in families of schizophrenic patients in high social contact with high-expressed emotion (EE) relatives significantly reduced the relapse rate for patients who remained on antipsychotic medication throughout the two years.
Medical Entomology and ZoologyBipolar Disorder: A Family-Focused Treatment Approach
401 Citations1997David J. Miklowitz, Michael J. Goldstein
Bipolar Disorder: Why Family Treatment?
American Journal of PsychiatryCourse and outcome in bipolar affective disorder: a longitudinal follow- up study
372 Citations1995Joseph F. Goldberg, Martin Harrow +1 more
Many contemporary bipolar patients demonstrate gradual improvement in the first several years after hospitalization, however, a subgroup approaching 60% still experience poor posthospital adjustment in one or more areas of functioning.
Journal of Consulting and Clinical PsychologyFamily-focused treatment versus individual treatment for bipolar disorder: Results of a randomized clinical trial.
370 Citations2003Margaret Rea, Martha C. Tompson +4 more
It is suggested that family psychoeducational treatment is a useful adjunct to pharmacotherapy in decreasing the risk of relapse and hospitalization frequently associated with bipolar disorder.
Archives of General PsychiatryOutcome in Manic Disorders
355 Citations1990Martin Harrow
It is suggested that many hospitalized manic patients have a severe, recurrent, and pernicious disorder; and in routine clinical practice, lithium carbonate treatment is an effective prophylaxis for fewer than the 70% to 80% of manic patients previously reported.
The British Journal of PsychiatryFamily-Based Intervention for Schizophrenic Patients in China
343 Citations1994Wei Xiong, Michael R. Phillips +5 more
This intervention is less costly than standard treatment, is suitable for urban families of schizophrenic patients in China and feasible given the constraints of the Chinese mental health system.
The British Journal of PsychiatryOutcome of Bipolar Disorder on Long-Term Treatment with Lithium
335 Citations1991Ralph A. O’Connell, Julia A. Mayo +3 more
The findings suggest there may be inherent differences in the pathophysiology of bipolar disorder reflected in an increased frequency of episodes which account for a large variance in lithium treatment outcome.
American Journal of PsychiatryTwo-Year Prospective Follow-Up of Children With a Prepubertal and Early Adolescent Bipolar Disorder Phenotype
311 Citations2002Barbara Geller, James L. Craney +4 more
The relatively poor outcomes of these subjects may be related to their phenotypic resemblance to severely ill adults with bipolar disorder who have mixed mania, continuous rapid cycling, psychosis, and treatment-resistant psychopathology.
JAMADifferential outcome of pure manic, mixed/cycling, and pure depressive episodes in patients with bipolar illness
293 Citations1986Martín Keller
It is proposed that this subtyping of episodes may be a clinically useful part of the classification of bipolar disorders.
Archives of General PsychiatryTwelve-Month Outcome After a First Hospitalization for Affective Psychosis
292 Citations1998Stephen M. Strakowski, Paul E. Keck +8 more
Few patients achieved a favorable outcome in the year after a first hospitalization for an affective psychosis, and low socioeconomic status, poor premorbid function, treatment noncompliance, and substance abuse were associated with lower rates or delayed onset of recovery.
PubMedStressful life events and social rhythm disruption in the onset of manic and depressive bipolar episodes: a preliminary investigation.
292 Citations1998Susan Malkoff-Schwartz, Ellen Frank +5 more
Evidence is found that life events characterized by SRDs routines are associated with the onset of manic, but not depressive, episodes, and severe events seem to be related to onset of bipolar episodes.
The British Journal of PsychiatryA Trial of Family Therapy v. a Relatives Group for Schizophrenia
289 Citations1989Julian Leff, Ruth Berkowitz +4 more
It is recommended that the most cost-effective procedure is to establish relatives groups in conjunction with family education and one or more initial family therapy sessions in the home, particularly important to offer home visits to families who are unable to or refuse to attend the relatives groups.
PubMedA double-blind trial of bupropion versus desipramine for bipolar depression.
279 Citations1994G S Sachs, Beny Lafer +5 more
A prospective double-blind trial to assess efficacy and rate of treatment-emergent mood elevation in depressed bipolar patients when bupropion or desipramine was added to an ongoing therapeutic regimen of lithium or an anticonvulsant suggests that bupropions is less likely to induce mood elevation than desipramsine.
Journal of Abnormal PsychologyIncreases in manic symptoms after life events involving goal attainment.
243 Citations2000Sheri L. Johnson, David Sandrow +5 more
It is hypothesized that life events involving goal attainment would promote manic symptoms in bipolar individuals, and results are congruent with a series of recent polarity-specific findings.
Psychological MedicineA pilot study of cognitive therapy in bipolar disorders
230 Citations2001Jan Scott, Anne Garland +1 more
The use of CT in subjects with bipolar disorders is more complex than in unipolar disorders and requires a high level of therapist expertise, but the therapy may prove to be particularly useful in the treatment of bipolar depression.
Applied and Preventive PsychologyA diathesis-stress conceptualization of expressed emotion and clinical outcome
210 Citations2000Jill M. Hooley, Ian H. Gotlib
A diathesis-stress conceptualization of EE is elucidated to explain both the development and manifestation of high EE in relatives of disordered patients and the impact of highEE on the course of patients' disorders.
Journal of Abnormal PsychologySocial support and the course of bipolar disorder.
199 Citations1999Sheri L. Johnson, Carol A. Winett +3 more
The Journal of Nervous and Mental DiseaseBipolar I: A Five-Year Prospective Follow-up
197 Citations1993Martín Keller, Philip W. Lavori +3 more
For those patients who relapsed, the mixed/cycling patients had the lowest cumulative probability of recovery from the first prospectively observed episode.
Psychiatric ServicesEffects of Psychoeducational Intervention for Married Patients with Bipolar Disorder and Their Spouses
197 Citations1998John F. Clarkin, Daniel Carpenter +3 more
American Journal of PsychiatryLithium Maintenance Treatment of Depression and Mania in Bipolar I and Bipolar II Disorders
181 Citations1998Leonardo Tondo, Ross J. Baldessarini +2 more
Lithium maintenance yielded striking long-term reductions of depressive as well as manic morbidity in both bipolar disorder subtypes, with greater overall benefits in type II patients and with earlier treatment.
Biological PsychiatryThe McLean–Harvard first-episode project: 6-month symptomatic and functional outcome in affective and nonaffective psychosis
176 Citations2000Mauricio Tohen, Stephen M. Strakowski +8 more
Syndromal recovery was achieved by nearly one half of patients within 3 months of a first lifetime hospitalization for a psychotic illness, but functional recovery was not achieved by 6 months in nearly two thirds of patients who had attained syndromal Recovery.
PubMedRandomised-control trial of family intervention for 78 first-episode male schizophrenic patients. An 18-month study in Suzhou, Jiangsu.
174 Citations1994Mei Zhang, Mingfu Wang +2 more
Journal of Affective DisordersA randomized clinical trial of inpatient family intervention V. results for affective disorders
164 Citations1990John F. Clarkin, Ira D. Glick +8 more
The results suggest that female bipolar patients and their families benefited from family intervention, whereas unipolar patients and families did not.
Biological PsychiatryPharmacologic agents for the treatment of acute bipolar mania
160 Citations2000Susan L. McElroy, Paul E. Keck
Although controlled data are accumulating to support the efficacy of several atypical antipsychotics in the treatment of acute bipolar mania, the novel antiepileptics need more extensive study before it can be concluded that any of them possess specific antimanic properties.
Behavior ModificationBehavioral Family Treatment for Patients with Bipolar Affective Disorder
145 Citations1990David J. Miklowitz, Michael J. Goldstein
The authors describe their adaptation of the educational, communication skills training, and problem-solving skills training modules of BFM to families containing a bipolar member, finding it necessary to be more flexible and less didactic.
American Journal of PsychiatryStress reactivity in bipolar patients and its relation to prior history of disorder
139 Citations1997Constance Hammen, Michael Gitlin
The British Journal of PsychiatryLithium Prophylaxis and Expressed Emotion
133 Citations1989Stefan Priebe, C Wildgrube +1 more
Patients living with high-EE relatives showed a significantly poorer response during the three years before interview, and an even poorer response in the nine-month follow-up, according to the CFI.
American Journal of PsychiatryOutcome of patients with chronic affective disorder: a five-year follow- up
124 Citations1990
Factors associated with recovery were less severe illness at intake, lack of psychotic features, good friendship patterns in adolescence, and, most important, a relatively high maximum level of functioning in the 5 years preceding intake.
The British Journal of PsychiatryBehavioural Family Management in Schizophrenia
122 Citations1994Eugenia T. Randolph, Spencer Eth +8 more
Depression and AnxietyBipolar depression: An underestimated treatment challenge
119 Citations1997Stefanie A. Hlastala, Ellen Frank +4 more
Manic patients were significantly more likely to achieve clinical remission than the depressed patients and did so significantly more rapidly, suggesting that psychotherapy has a limited impact in the acute phase treatment of bipolar episodes.
Journal of Abnormal PsychologyBipolar disorder and family communication: Effects of a psychoeducational treatment program.
108 Citations1999Teresa L. Simoneau, David J. Miklowitz +3 more
The positive effect of family treatment on patients' symptom trajectories over 1 year was partially mediated by increases in patients' positive nonverbal interactional behaviors during this same interval.
Journal of Abnormal PsychologyAdjunctive psychotherapy for bipolar disorder: Effects of changing treatment modality.
106 Citations1999Ellen Frank, Holly A. Swartz +4 more
Journal of Affective DisordersPredictors of outcome in prophylactic lithium treatment: a 2-year prospective study
101 Citations1990Jørgen Aagaard, Per Vestergaard
It is suggested that patients with substance abuse should not be offered prophylactic lithium treatment unless intensive control and support is practicable, and patients with a chronic course need a more effective treatment than lithium can offer.
Journal of Clinical PsychopharmacologyBipolar Mood Disorder: Practical Strategies for Acute and Maintenance Phase Treatment
99 Citations1996Roy H. Perlis
Recommendations for treatment strategies based on the phase and stage of the illness are organized into algorithms that emphasize the use of mood-stabilizing medications as initial steps in a systematic, iterative approach to treatment.
The British Journal of PsychiatryEfficacy of Lithium Prophylaxis in Clinical Practice
91 Citations1989Hameen Markar, A. J. Mander
The efficacy of lithium prophylaxis in bipolar affective disorder in clinical practice and the benefits conferred by the prescription of this drug were modest compared with the results from clinical trials.
PubMedThe longitudinal course of bipolar disorder.
85 Citations2000Trisha Suppes, Ellen B. Dennehy +1 more
Findings on age at onset, psychiatric comorbidity, frequency of episodes, cycle pattern, rapid cycling, mixed symptoms, and precipitants of episodes including use of substances and antidepressants and lithium discontinuation are discussed.
Archives of General PsychiatryAdherence to Treatment Regimen in a Lithium Carbonate Clinic
81 Citations1982Catherine E. Connelly
Elevated mood, marriage, and perception of continuity of care was associated with adherence to drug regimen and appointment-keeping adherence, and no association was found between nonadherence and diagnostic subcategory or between adherence and reported side effects.
Archives of General PsychiatryResponse to Maintenance Therapy in Bipolar Illness
74 Citations1989Deborah R. Shapiro
An interaction between treatment and the nature of the index episode (the episode that brought the patients into the study) was found and both lithium and the combination were superior to imipramine.
PubMedMoods, misattributions and mania: an interaction of biological and psychological factors in the pathogenesis of mania.
64 Citations1989David Healy, Jacob M. Williams
It is proposed that changes in circadian rhythm dysfunction lead to the typical clinical picture of mania when distorted cognitively by mechanisms similar to those found in depression.
Journal of Consulting and Clinical PsychologyPredictors of work adjustment in bipolar I patients: A naturalistic longitudinal follow-up.
57 Citations2000Constance Hammen, Michael Gitlin +1 more
Overall, presence of a good quality supportive relationship was the strongest unique predictor of work, and the results highlight the need to study functional outcomes in patients, especially because they appear only modestly associated with clinical status.
PharmacopsychiatryAdherence to Lithium Prophylaxis: II. Multivariate Analysis of Clinical, Social, and Psychosocial Predictors of Nonadherence
53 Citations1988Jørgen Aagaard, Per Vestergaard +1 more
In the multivariate logistic analysis the most informative clinical, social, and psychosocial predictors were, in rank order: many admissions to mental hospitals, death or divorce of parent in childhood, heavy smoking, short duration of the mental disorder diagnosed as affective, not married, never economically active, and early onset of the affective disorder.
Comprehensive PsychiatryInterpersonal problem-solving therapy for schizophrenics and their families
46 Citations1981Robert Paul Liberman, Charles J. Wallace +2 more
While both groups showed equivalent degrees of improvement in psychopathology during the inpatient treatment period, twice as many patients relapsed and required rehospitalization in the holistic health therapy group than in the social skills training group.
Family ProcessEvaluating Therapist Competency and Adherence to Behavioral Family Management with Bipolar Patients
42 Citations1998Amy Weisman, Sumie Okazaki +5 more
Overall, clinicians adhered closely to the BFM manual and specific areas in which there was high competency and treatment adherence were (a) skill in conveying factual information about bipolar illness, (b) establishment of a therapeutic environment, and (c) ability to take command of therapy sessions.
Statistics in MedicineCausal estimation of time‐varying treatment effects in observational studies: Application to depressive disorder
35 Citations1994Philip W. Lavori, Ree Dawson +1 more
Data from a large observational study of the course of affective illness is used, to illustrate an approach to issues arising from assessing temporal treatment effects due to nonrandomized treatment assignment over time.
PharmacopsychiatryPredictors of Compliance with Lithium and Carbamazepine Regimens in the Long-Term Treatment of Recurrent Mood and Related Psychotic Disorders*
25 Citations1989Andrea Lenzi, F. Lazzerini +3 more
Patients were more likely to stay in treatment when prophylaxis was begun following a depressive episode and in the presence of congruent psychotic experiences.
